Tear trough injections to help with the appearance of my dark circles, but I have yet to see any results after 2 weeks. (photos)

After paying almost $800 for tear trough injections with the filler, Belotera two weeks ago I haven't seen much of a difference in the appearance of my dark circles, in fact they look even darker than before and I am not bruised or swollen. Is this normal? Does it take a while to see results? Am I just an unlucky case? My dermatologist is telling me that the fillers do not lighten the darkness, but just fill the indentations. Is there anything I can do to lighten them

Doctor Answers 11


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belotero help to fill out the tear troughs which can help the appearance of dark circles. There are other options to help this problem as well. I would recommend discussing this with your injector.

Belotero for contour

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Belotero is used for fine lines and to contour the tear trough depression.  However, it will not remove or hide dark circles in these areas.

Beletero used for dark circles in the for tear trough area, not seen the results even after 2 wks. What else can I do?

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The before and after image quality of your photos are not consistent. I would wait for 2 more weeks till the tissue heals completely and then go back to your physician and compare your photos. The are many different causes and treatments for under eye circles. Fillers are known to improve the dark circles not the skin pigmentation.

I believe using Platelet rich plasma treatment under the eye might improve the discoloration of the skin in your situation.

Best Wishes

Dr. Shanthala   

Belotero for undereye injections

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It is hard to assess your results with the provided photos since the lightning and position is different in each of the photos. Both Belotero and Restylane are great fillers for treating the tear trough, the latter being my preferred filler because it last longer. Undereye dark circles can have several causes including volume loss, pigmentation, vascularity and swelling. Fillers treat volume loss but not the other causes. Lasers, lightening creams, and peels can be used to address pigmentation. A vascular laser can be used to treatment underlying veins. Swelling is very hard to treat and usually requires avoidance of the things that worsen the swelling such as salt and alcohol. 

In most patients the cause of undereye dark circles is multifactorial and so combination treatments work best. 

Complex Anatomical Deformities May Require Multiple Modalities For Optimal Treatment

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Your question raises many important points worthy of discussion.  Perhaps the most basic is that in assessing the results of an aesthetic treatment, you have to compare like with like to arrive at any sort of realistic evaluation. Your post-treatment photo is taken from above at a distance, looking obliquely downward. Your pretreatment photo is taken close up, from a less oblique direction and almost level with the eyes.  

The lighting in the two photos is also completely different, with much more shadowing in the pretreatment photograph. It thus becomes extremely difficult to compare your pre and post treatment photos.  That said, it actually does appear that you did experience some improvement in your tear troughs from your belotero injections.  

Additionally, you must bear in mind that the "tear trough deformity" is a multifactorial deformity, that may involve morphological variances in the topography of the orbit and malar bones, loss of fat at the lid/cheek junction, thinning of the skin, actinic skin damage, pigmentation issues, etc.  Problems such as these often require a multimodality approach to optimally address these issues. Thus, in addition to the injection of more or different fillers, you may also consider undergoing a lower lid blepharoplasty with lateral canthopexy, skin excision, septal reset and fat transposition; a chemical peel; or laser treatment of the skin of the cheek and periorbital region. 

Under eye fillers

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You appear to have good results after under eye filler with belotero- I routinely use belotero and its a great filler for that area. The difference in the first and third picture is the lighting, the lighting in the first picture after the filler is from above so the TT area looks great, and the light in the third picture with the light from more 'below'- really accentuates the area because you have nice fullness in your cheeks. Your options to further improve are to do the following

1- more filler- further soften the shadowing

2- treat the pigment (if you have any, i can't tell from the pictures)- options vary from laser skin resurfacing, to micro needling to PRP injections. 

Hope this helps

Belotero/Tear Trough

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It does take some time, but 2 weeks should be sufficient to see the results of the filler.  The darkness that you perceive is a shadow.  The goal of the filler is to add volume to the area, hence raising the indentation and eliminating the shadow or perceived "bags".  I typically use Restylane for the tear trough area as it is slightly more hydrophilic and absorbs more water, but Belotero is used by many with good success.  I do think based on your photos that you are a good candidate for filler and I can't explain why you didn't see much benefit with your initial injection.

Christian Paquet, MD
Beverly Hills Physician

Belotero and tear trough

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Belotero is an excellent filler but it appears that you may need more filler such as Restylane. In addition genetics plays a part and you may also need lasers or microneedling as well. Please consult an expert. Best, Dr. Green

Here are next steps...

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Usually this requires a combination approach. The dark bags you have are genetic and can be treated with lower eyelid surgery or require a combination of fillers, lasers, and microneedling/PRP. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 203 reviews

Tear trough injections to help with the appearance of my dark circles, but I have yet to see any results after 2 weeks. (photos)

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There are several causes of dark circles under the eyes, and filler can help minimize some but not all of those causes. Where there is an appreciable valley, the valley can be filled with filler. This minimizes shadow, which is one cause of the dark circles. However, other factors like amount of sleep, hydration status, and differences in skin pigment also affect this area. Hydration and sleep are obvious, but if the issue is pigment, you may consider a topical or laser treatment to see if that helps. My advice would be to go back to your plastic surgeon and see what other options are available. 

Hope that helps!


Christopher D. Knotts, MD, FACS
Reston Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.